Management of vascular injury during VATS lobectomy with hemostatic matrix sealant agent: a case report

Vascular injury is the most dreadful complication during a video-assisted thoracoscopic surgery (VATS) lobectomy and often lead to conversion to thoracotomy. While the rate of this event considerably drops with the progression on surgical team’s learning curve, however, it is always useful to have an emergency plan to deal with it. The repairing approaches described in literature are mostly based on suction-compression angiorrhaphy technique (SCAT), involving a suture on the damaged vessels. In our case-report we display a good alternative to SCAT when we are dealing with small size lesions, without resorting to conversion. A 63-year-old with lung adenocarcinoma underwent a right upper VATS lobectomy: during the procedure, an iatrogenic lesion to intrascissural upper lobe artery occurred. We made use of suction and compression but, instead of performing a suture on the vessel, we applied hemostatic matrix sealant agent. The bleeding was effectively stopped and the wound sealed, allowing us to safely carry out the lobectomy without conversion to thoracotomy. No post-operative complications were highlighted and the patient was still alive after 6 months since the procedure. Our approach could be a useful addition to techniques already described and could be easily executed by surgeons still in learning curve. This is the first case of vascular injury managed specifically with only hemostatic matrix sealant agent described in literature and it has proven effective as well as the angiorrhaphy technique when it comes to small size artery lesions. Thanks to the easiness of sealant application, execution time of our method is shorter than a more complex repair in VATS, allowing inexperienced surgeons to fix the injury with little effort.